As a researcher using constructivist Stake (1995) case study methodology, it is important to remember that we must have an active personal role in data collection and analysis. As constructivists we believe knowledge is constructed during interaction between the researcher and the participants. Alternatively, in post-positivist research, the researcher is often asked to shelve their beliefs and to collect and analyze data with no influence (Denzin & Lincoln, 1994). When the researcher becomes involved, multiple different interpretations of reality are formed (Merriam, 1998) and I believe in order to help understand the data as it was created by the participants in conjunction with the research team, a reflexivity piece is required.
It is important as a constructivist researcher that I practice reflexivity (Finlay, 2002). This can be done by stating my preconceived notions and assumptions about the research and discuss how they affected my interpretation of the data. Since the beginning of this project I have been forming opinions, impressions, and interpretations by reading, reflextive note taking, and formal data collecting with participants. It is this constant
learning and interpretation that has caused the evolution of my research question throughout this process, something Stake (1995) believes is necessary during research. The decision to engage in this particular research project came after a discussion with the principal investigator. She had worked alongside the Founding Organization in the past, evaluating their initial COPD management program, and as a result knew their program and implementation strategy well. The initial iteration of the program was studied and understood to be a notable success as determined by measuring patient outcomes. As a result, upon the commencement of my research project, I possessed an understanding that the COPD management program was, in itself, a successful program.
This understanding, although backed up by statistics from the first implementation (Ferrone et al., 2019), influenced the way I interpreted my results. Although I found the majority of results to be clearly positive, I believe that on occasion, I may have been more likely to code in a positive manner rather than neutral or negative. This was as a result of my pre-conceived notion of the COPD management program being a success. Although I do believe that my interpretation of the data fit with proper constructivist methodology, due to this, there may exist other interpretations of which I was not immediately aware of. These interpretations may have been understood by another
researcher unaware of the Founding Organization’s original implementation of the COPD management program.
Throughout this research project there was no greater dilemma for me than choosing my ontological perspective. Being torn between constructivist and post-positivist lenses was difficult, because it made me think about how knowledge is created in different
circumstances. I realized that I need not select an ontological perspective for the rest of my life, but that it may change depending on the nature of the research I undertake. I realized although post-positivism has its place in research and would have been certainly adequate, constructivism was the appropriate perspective for this particular case study. If I had to do this project again, there are two things I would have incorporated with the benefit of hindsight. First, I would have used an inductive coding technique in addition to
a deductive technique for all of the interviews and focus groups, not solely the patient focus group. Doing so would have allowed me to compare those results with my current results for similarities and differences. Additionally, it would allow me to test CFIR’s comprehensiveness for provider data. Secondly, I would try a post-positivist approach. This would allow me to flex my Yinnian (Yin 2002; Yin, 2012) muscles and challenge the research question from an alternative point of view. I believe it would offer me a different insight into the B-FHT case studied.
Overall, I believe the addition of an inductive coding process was successful in bringing out themes that otherwise would not have been evident if a solely deductive framework was utilized. Some of the inductive themes that emerged aligned with the deductively coded constructs, showing consistency. Although the inductive coding required more analysis because the data did not all fit into previously determined constructs, it was a useful tool in exploring patient views on program implementation. I would recommend it for use in the future when analyzing qualitative patient data in conjunction with CFIR. In the end, I was able to gain considerable perspective and experience taking part in this research project and am quite content with the result; a constructivist case study of a chronic disease management program rooted in implementation science theory.
5.9
Summary
The purpose of this chapter was to discuss the findings of my research in relation to current literature. In addition to this, each construct was compared to the results of two systematic reviews (Davy et al., 2015; and Kadu & Stolee, 2015), which examined facilitators and barriers affecting the implementation of chronic care models in primary care. Examples from data were given to substantiate the comparison and show the degree of alignment with the literature. After this, discussion was centered on the fulfilment of the research objectives. Finally, the chapter included sections on limitations and
reflexivity. The next chapter will discuss the implications of these findings in various contexts including future research, policy/system, and practice.